Annals of Occupational and Environmental Medicine

Cohort Profile (includes Data Profiles)

Occupational and Environmental Health Screening Cohort of Yangsan Korea (OEC-YK): 2012–2023: Dongmug Kang, Eun-Soo Lee, Se-Yeong Kim, Youngki Kim, Youn Hyang Lee, Yoon-Ji Kim; Ann Occup Environ Med 2025;e32. Published online September 5, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e32 [Accepted]

Abstract PDF: The Occupational and Environmental Health Screening Cohort of Yangsan Korea (OEC-YK) was established to monitor long-term health outcomes in workers and environmental high-risk citizens through systematic periodic health examinations. The cohort integrates 623,402 examination instances from 105,768 participants at Pusan National University Yangsan Hospital (2012–2023), encompassing general health checkups, occupational exposure surveillance, cancer screenings, and others including asbestos-related surveillance. Examination types included general health examination (32.4%), cancer screening (20.6%), special health examination (16.2%), night-shift work examination (16.0%), chronic disease screening (4.8%), pre-placement examinations (2.1%), and asbestos-related surveillance (3.6%). At baseline, 59.0% were male and 75.5% were aged between 20 and 59 years. Follow-up rates reached 35.0% at 1 year, 31.9% at 2 years, and 3.2% at 11 years. Notably, the inclusion of systematic asbestos examinations, combined with a national asbestos job exposure matrix, allows detailed study of long-latency occupational diseases. This large-scale longitudinal dataset supports exposure-disease linkage analysis, job-exposure integration, and time-series modeling of worker health trajectories in Korea.

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Review article

The status and implications of paid sick leave and sickness benefits in OECD countries: Jaehoon Lee, Jinwoo Lee, Sang Baek Koh; Ann Occup Environ Med 2025;e21. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e21 [Accepted]

Abstract PDF: The experience of the coronavirus disease 2019 pandemic has highlighted the importance of paid sick leave and sickness benefits, and is creating an international movement to introduce or improve real-world systems. The Organisation for Economic Co-operation and Development (OECD) countries except Korea and the United States already have statutory paid sick leave or sickness benefits, with the United Kingdom extending statutory paid sick leave to low-income workers in 2025, and Ireland introducing statutory paid sick leave in 2023. In the United States, 18 states, including Minnesota in 2024 and Alaska and Missouri in 2025, as well as the District of Columbia, have introduced statutory paid sick leave (as of December 2024). Furthermore, an analysis of 33 OECD countries with statutory paid sick leave or sickness benefits suggests that 21 countries comply with the International Labour Organization (ILO) Convention standards for adequacy of benefits and comprehensiveness of coverage, while six countries with social assistance have high comprehensiveness of coverage but low adequacy of benefits. There was not a single country with a program that had low levels of both benefit adequacy and coverage. In Korea, the pilot sickness benefit program has been extended until 2027, and the system has been delayed. The principles of benefit adequacy and coverage comprehensiveness must be upheld for the purpose and intent of the program to ensure adequate care and rest. Consequently, in addition to adhering to the standards outlined in the ILO Convention, the implementation of paid sick leave should be codified in legislation to enhance employer accountability.

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Review article

Medical certification in sickness benefit schemes (I): theoretical perspectives and return-to-work: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;e23. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e23 [Accepted]

Abstract Abstract in Korean PDF: This study explores the theoretical foundations and practical applications of medical certification within the sickness benefit systems, particularly in the context of Korea’s pilot program and its planned national rollout. While sickness benefit systems have long existed in many Organization for Economic Cooperation and Development (OECD) countries, Korea has only recently initiated pilot projects, largely prompted by the coronavirus disease 2019 pandemic. These systems aim to compensate for income loss due to illness or injury, and medical certification plays a central role in determining eligibility and work ability. This study defines medical certification as a two-stage process: clinical diagnosis and formal assessment of a worker’s ability to return-to-work. The dual nature highlights the distinct objectives of the medical treatment and social security policies. Drawing on international practices, this study reviews the International Classification of Functioning, Disability, and Health (ICF) as a key global framework for assessing disability and work ability, although it acknowledges the limitations of its application to sickness benefits. The research emphasizes a shift in global trends toward return-to-work–oriented certification models, such as the UK’s “fit note” system, which focuses on evaluating fitness-for-work rather than merely documenting illness. Sweden and Japan also offer models that integrate rehabilitation with flexible work accommodations. Three key issues were identified in Korea’s system: the role of medical certification and concerns about moral hazard, the burden of proof and workload on physicians, and public perceptions of the program’s purpose. We believe that medical certification should not only verify illness but also support early intervention and a healthy workforce. Ultimately, this study advocates for a balanced and efficient medical certification system tailored to Korea’s healthcare context closely aligning with labor market policies to ensure long-term sustenance and integration of the sickness benefit program.; 상병수당 제도에서의 의료인증체계(1): 이론적 배경과 직장복귀
본 연구는 한국의 시범사업과 향후 전국적 시행을 앞둔 상황에서 상병수당 제도에서 의료인증의 이론적 기반과 실제적 적용을 살펴보고자 하였다. 상병수당 제도는 많은 OECD 국가에서 오래전부터 시행되어 왔으나, 한국에서는 COVID-19 팬데믹을 계기로 최근에야 시범사업이 시작되었다. 이 제도는 질병이나 부상으로 인한 소득 상실을 보상하는 것을 목적으로 하며, 의료증명은 수급 자격 및 업무 수행 능력을 판단하는 핵심적 요소이다.
의료인증은 진단이라는 1단계와, 업무복귀 가능성을 공식적으로 평가하는 2단계로 구성되며, 이는 의료적 목적과 사회보장 정책 목적의 차이를 드러낸다. 국제적 관행을 참고하여, 본 연구는 장애 및 업무능력 평가의 세계적 기준인 ‘기능장애건강국제분류(ICF)’를 검토하되, 이를 상병수당에 적용하는 데 있어 한계점도 지적한다. 연구는 세계적으로 ‘복귀 중심(return-to-work)’ 의료증명 체계로의 전환이 이루어지고 있음을 강조한다. 예를 들어, 영국의 ‘핏 노트(fit note)’ 제도는 단순한 질병 증명에서 벗어나 업무수행 가능성을 평가하는 방식이다. 스웨덴과 일본은 재활과 유연한 업무조정을 포함한 모델을 운영 중이다.
한국 제도 설계에서 중요한 세 가지 이슈는 의료인증의 역할과 도덕적 해이 우려, 의료진의 입증 책임 및 행정 부담, 그리고 제도 목적에 대한 대중의 오해이다. 본 연구는 의료적 증명이 단순한 질병 확인을 넘어 조기 개입과 건강한 노동력 유지로 이어져야 한다고 주장한다.
궁극적으로 본 연구는 한국의 의료이용 환경에 적합하고 노동시장 정책과 조화를 이루는, 균형 있고 효율적인 의료증명 체계의 구축을 제안한다. 이는 상병수당 제도의 지속 가능성과 신뢰성을 확보하는 데 핵심적인 요소다.

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Review article

Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;e24. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e24 [Accepted]

Abstract Abstract in Korean PDF: Work disability evaluation plays a central role in medical certification in sickness benefit schemes. This guides effective decision making for return-to-work timelines. Countries that incorporate it have varied approaches. To improve fairness and consistency, Sweden adopted disease-specific guidelines, particularly for complex health conditions such as mental disorders, cancer, and neurological diseases, whereas in the United Kingdom, a fit note system highlights the ease of fitness-for-work assessments in clinical settings. For a successful implementation of the sickness benefit scheme in Korea, it is essential to review international acumen in work disability evaluation and medical certification. This study also examines challenges that physicians face in certification, factors influencing assessments, and the usefulness of disease-specific guidelines. In many countries, administrative burdens, uncertainty in diagnosis, and ethical conflicts complicate physicians' tasks. Countries such as Sweden, France, and Ireland, have addressed these issues by developing structured certification tools and support systems. Learnings from the recent Korean pilot programs, this review identifies the following core priorities: developing disease-specific guidelines, providing clinical support for physicians’ decisions, and integrating occupational health expertise. These guidelines should function not only as administrative checklists, but also as potential clinical tools that consider both patient functionality and job characteristics. Finally, this study offers policy and practical insights to help design a consistent and fair medical certification system for Korea’s sickness benefit program that encourages timely medical intervention, prevents presenteeism, and promotes sustainable workforce reintegration.; 상병수당 제도에서의 의료인증체계(2): 근로능력 평가의 실제
근로능력 평가는 상병수당 의료인증체계에서 가장 핵심적인 요소로, 근로활동불가기간을 정확히 산정하여 근로자의 적절한 직장복귀를 지원한다. 국가마다 근로능력 평가 방식은 상이하며, 형평성과 일관성을 제고하기 위해 스웨덴 등은 질병별 가이드라인을 도입하였다. 특히 스웨덴은 정신질환, 암, 신경계 질환과 같이 평가가 어려운 질병군까지 포함하는 포괄적인 지침을 보유하고 있다. 영국의 핏 노트 제도는 업무적합성 평가를 임상 현장에서 어떻게 적용할 수 있는지에 대한 구체적 사례를 제공한다.
한국의 상병수당 제도가 성공적으로 도입되기 위해서는, 근로능력 평가와 상병수당 의료인증에 관한 국제적 경험을 고찰하는 것이 필수적이다. 본 연구에서는 의료인증 과정에서 의사가 겪는 어려움, 근로능력 평가에 영향을 미치는 요인, 질병별 가이드라인의 활용 가능성 등을 함께 분석하였다. 여러 나라에서 진단 불확실성, 행정 부담, 윤리적 갈등 등으로 인해 의료진이 인증 업무에 어려움을 겪고 있으며, 스웨덴·프랑스·아일랜드 등은 이를 해결하기 위해 구조화된 인증 도구와 지원 체계를 마련하고 있다.
한국의 시범사업 경험을 바탕으로, 본 논문은 질병별 가이드라인 개발, 임상의의 의사결정 지원 체계 마련, 직업보건 전문성의 제도적 통합을 제시하고자 하였다. 이러한 지침은 단순한 행정 문서가 아닌, 환자의 기능과 직무 특성을 반영한 임상 도구로서 기능해야 할 것이다.

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Original article

Health effects of weekend work on Korean workers: based on the 6th Korean Working Conditions Survey: Ji-Hyeon Lee, Jin-Young Min, Seok-Yoon Son, Seung-Woo Ryoo, Kyoung-Bok Min; Ann Occup Environ Med 2025;e31. Published online September 3, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e31 [Accepted]

Abstract PDF: Background
Although weekend work makes up a significant part of work patterns in modern society, research on the health effects of weekend work is relatively limited compared to other types of nonstandard work. This study was conducted to examine the impact of weekend work on the health of Korean workers, aiming to provide evidence to support the development of welfare policies that promote workers’ health.
Methods
This study was conducted using data from the 6th Korean Working Conditions Survey, targeting 35,957 Korean workers who met the research criteria. Based on the survey responses, information was collected on weekend work status and health outcomes, including general health, musculoskeletal pain, headaches or eye pain, fatigue, sleep disorders, depression, anxiety, absenteeism and presenteeism. To examine the association between weekend work and health outcome variables, logistic regression analysis was performed adjusting for sociodemographic and occupational characteristics, with additional stratified analyses conducted according to employment status.
Results
Among the final study population, 11,255 workers, accounting for 30.48% of the total, were weekend workers. After adjusting for sociodemographic and occupational characteristics, weekend work was found to be significantly associated with depression (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.00–1.18), anxiety (OR: 1.35; 95% CI: 1.16–1.58), musculoskeletal pain (OR: 1.45; 95% CI: 1.34–1.58), fatigue (OR: 1.49; 95% CI: 1.36–1.62), absenteeism (OR: 1.70; 95% CI: 1.43–2.03), and presenteeism (OR: 1.82; 95% CI: 1.62–2.04). The health effects of weekend work differed between the self-employed and employees, as shown in the results of the stratified analysis.
Conclusions
Weekend work was found to increase the risk of both physical and mental health problems of Korean workers, and the effect varied according to employment status. There is a need to design a comprehensive occupational health policy that reflects the characteristics of different employment statuses.

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Original article

Association between serum iron levels and low-frequency hearing loss in Korean females: Inho Jung, Seunghyeon Cho, Sunjin Jung, JiHwan Kim, Won-Ju Park; Ann Occup Environ Med 2025;e28. Published online September 2, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e28 [Accepted]

Abstract PDF: Background
This study investigates the association between serum iron levels and frequency-specific hearing loss in Korean female population, a topic previously unexplored in auditory health research.
Methods
This study enrolled Korean female participants from the general population. Serum iron levels and hearing thresholds at low (1 kHz) and high (4 kHz) frequencies were assessed, adjusting for potential confounders. Participants were stratified into quartiles based on serum iron levels.
Results
The mean age of the study population was 51.1 ± 10.1 years. Among the 2,987 participants, 344 (11.5%) had abnormal low-frequency hearing thresholds, and 719 (24.1%) had abnormal high-frequency thresholds. Multiple linear regression analysis demonstrated a significant negative association between serum iron levels and low-frequency hearing thresholds (β = –0.012, p = 0.017), whereas no significant association was observed with high-frequency thresholds (β = –0.006, p = 0.352). In a stratified analysis using 50 years (the average menopausal age) as a cutoff, no statistically significant association was identified in participants younger than 50 years. However, in those aged 50 years and older, the negative association between serum iron levels and low-frequency hearing thresholds remained statistically significant.
Conclusions
This study is the first to identify an association between serum iron levels and low-frequency hearing loss in females aged 50 years and older, underscoring the potential role of iron in auditory function. These findings highlight the importance of further research in diverse populations to elucidate the underlying mechanisms and broader clinical implications.

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Original article

Occupational skin diseases among cathode material workers in the Korean lithium-ion battery industry: a descriptive case series: Hwa-Yeon Lee, Dong-Hee Koh, Junhyeok Choi, Yong Lim Won; Ann Occup Environ Med 2025;e29. Published online September 2, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e29 [Accepted]

Abstract PDF: Background
Occupational skin diseases are common in industrial settings; however, few studies have examined workers involved in the production of lithium-ion battery cathode-active materials. This study aimed to investigate the patterns and factors associated with skin diseases in these workers.
Methods
Overall, 37 workers with a history of skin disease were recruited from two cathode-active material manufacturing companies. Onsite investigations, semi-structured interviews, and workplace observations were conducted. Information on skin symptoms, affected areas, symptom frequency, and aggravating factors was collected.
Results
The most commonly reported symptoms were pruritus (27.5%), erythema (20.3%), and chemical burns (15.9%). The most commonly affected areas were the hands and forearms (47.2%), whereas 18.9% of workers reported symptoms in unexposed areas, such as the thighs. The symptoms tended to worsen on workdays and improved during holidays. Less-experienced workers reported more frequent symptoms.
Conclusions
Skin diseases during cathode material production appear to be primarily caused by irritants and allergic contact dermatitis, as well as chemical burns caused by exposure to metal dust, such as lithium, nickel, and cobalt. An urgent need exists for appropriate personal protective equipment, improved work environments, and targeted education for new workers.

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Original article

Factors affecting heat-related illness symptoms among school food service workers: a cross-sectional study in Korea: Nahyun Kim, Dongwhan Suh, Jia Ryu, Woo Chul Jeong, Yun-Keun Lee, Jinwoo Lee, Hyunjoo Kim; Ann Occup Environ Med 2025;e30. Published online September 2, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e30 [Accepted]

Abstract PDF: Background
School food service workers are highly likely to develop heat-related illnesses because of their work environment. However, studies that have examined the risk of heat-related illnesses among them are limited. The purpose of this study was to investigate the status of heat exposure, implementation of heat wave countermeasures, and prevalence of heat-related illness symptoms among school food service workers in Korea, and to explore the relationship between them.
Methods
A cross-sectional study was conducted through an online survey of school food service workers from May 25 to June 12, 2023, via three labor unions. We analyzed 6,244 valid responses. We assessed general characteristics, heat-related illness symptoms (heat rash, heat cramps, heat edema, heat exhaustion, heat syncope), duration of heat exposure during heat waves, and heat wave preventive measures. Multiple logistic regression analyses were performed, with adjustments for age, occupation, hypertension, diabetes, and school type.
Results
More than one-third of school food service workers reported heat exposure between May and September exceeding 4 hours daily, and 94.6% experienced at least one heat-related illness symptom during the last year. A dose-response relationship was observed between heat exposure duration and heat-related illness symptoms (p for trend < 0.001). School food service workers who did not have increased rest periods or did not reduce high-heat prepared foods showed significantly higher odds ratios for heat-related illness symptoms.
Conclusions
School food service workers experience substantial heat exposure and a high prevalence of heat-related illness symptoms. The risk of heat-related illness symptoms was associated with extended duration of heat exposure. Increasing rest periods and reducing high-heat food preparation were effective preventive measures. These findings underscore the need for improved heat exposure management and implementation of effective preventive measures to protect the health of school food service workers, with particular attention to appropriate rest periods.

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